Saturday, July 9, 2016

Acupressure helped reduce persistent fatigue in women who had been treated for breast cancer, a new study finds.

Fatigue is one of the most common long-term effects of breast cancer treatment. About a third of women experience moderate to severe fatigue up to 10 years after their treatment ends.

The study, published in JAMA Oncology, found acupressure reduced fatigue by 27 percent to 34 percent over six weeks. Two-thirds of women who did relaxing acupressure, a certain type of the healing method, achieved normal fatigue levels.

"Fatigue is an underappreciated symptom across a lot of chronic diseases, especially cancer. It has a significant impact on quality of life. Acupressure is easy to learn and patients can do it themselves," says study author Suzanna Zick, N.D., MPH, associate research professor of family medicine at the University of Michigan.

Acupressure is derived from traditional Chinese medicine. It involves applying pressure with fingers, thumbs or a device to specific points on the body. Researchers tested two types of acupressure: relaxing acupressure, which is traditionally used to treat insomnia, and stimulating acupressure, which is used to increase energy. The two techniques differ by which points on the body are stimulated.

Researcher recruited 424 breast cancer survivors from the Michigan Tumor Registry. Participants were randomized to relaxing acupressure, stimulating acupressure or usual care, which includes typical sleep-management techniques. The women were taught how to find and stimulate the acupressure points so that they could perform it at home once per day for six weeks.

At the end of the trial, both acupressure treatments resulted in significant, sustained improvements in fatigue. But only relaxing acupressure also improved measures of sleep quality, such as disrupted sleep, and overall quality of life.

Previous studies suggest acupuncture might help curb fatigue. But acupuncture is often not covered by insurance, plus it requires people go to a practitioner once or twice a week for at least six weeks.

Acupressure, on the other hand, proved in this study to be easy to learn, and it can be done at home.

Study participants had 15 minutes of training, and were able to accurately locate the correct acupressure points and apply the right amount of pressure. Some women reported minor bruising at the acupressure sites. About 12 percent of the participants discontinued the study because they felt it was too time-intensive.

"Given the brief training required to learn acupressure, this intervention could be a low-cost option for treating fatigue," Zick says.

The researchers are developing a mobile application to teach acupressure. They will also investigate why acupressure impacts fatigue and whether it is also effective for patients in active treatment and with cancers other than breast.

A diagnosis of high cholesterol is associated with reduced mortality and improved survival in the four most common cancers, according to research presented today at Frontiers in CardioVascular Biology (FCVB) 2016.1 The 14 year study from nearly one million patients found that a high cholesterol diagnosis was associated with lower risk of death in lung, breast, prostate and bowel cancers.

"The discovery of a link between obesity and high cholesterol as risk factors for cancer has been exciting for researchers and the public," said lead author Dr Paul Carter from the ACALM Study Unit at Aston Medical School, Aston University in Birmingham, UK. "Even trendier is the idea that if high cholesterol can cause cancer, then cholesterol lowering interventions such as statins could reduce this risk."

He continued: "We previously found an association between having high cholesterol and developing breast cancer.2 Animal studies show that giving statins for high cholesterol can reduce the risk of breast cancer. We wanted to see if there was any effect of high cholesterol on mortality amongst cancer patients."

The current study investigated the association between high cholesterol and mortality in patients with lung, breast, prostate and bowel cancer, the four most common cancers in the UK. Patients admitted to UK hospitals with these cancers between 1 January 2000 and 31 March 2013 were recruited from the Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) clinical database, which also had information on co-existing conditions such as high cholesterol. Mortality data was obtained from the Office for National Statistics.

Out of a total of 929 552 patients in the ACALM study, 7997 had lung cancer, 5481 had breast cancer, 4629 had prostate cancer, and 4570 had bowel cancer.

After adjusting for factors which might influence mortality, including age, gender, ethnicity, and the ten most common causes of death in the UK, the researchers found that patients with cancer were less likely to die if they had a diagnosis of high cholesterol than if they did not. Having a diagnosis of high cholesterol was associated with a 22% lower risk of death in patients with lung cancer, 43% lower risk of death in breast cancer, 47% lower risk of death in prostate cancer, and 30% lower risk of death in bowel cancer.

Dr Carter said: "Our research suggests that there's something about having a high cholesterol diagnosis that improves survival and the extent to which it did that was quite striking in the four cancers studied. Based on previous research we think there's a very strong possibility that statins are producing this effect."

He continued: "Because we saw the association amongst all four cancers we studied, we think this effect is caused by medications used for high cholesterol such as statins. These findings are likely to be seen in other cancers as well but this is only speculation and would need to be confirmed by studies in different types of cancer."

Dr Rahul Potluri, senior author and founder of the ACALM Study Unit, said: "Statins have some of the best mortality evidence amongst all cardiovascular medications and statin use in patients with a diagnosis of high cholesterol is possibly the main reason that this diagnosis appears to be protective against death in patients with lung, breast, prostate and bowel cancer. Other cardiovascular medications may also be protective and explain the varying levels of risk reduction in the four cancer types. For example, prostate cancer is associated with heart disease and these patients tend to take ACE inhibitors and beta-blockers."

He added: "The results of this study strengthen the argument for a clinical trial evaluating the possible protective effect of statins and other routinely used cardiovascular medications such as aspirin, blood pressure medications, beta-blockers and ACE inhibitors in patients with cancer. Whether it is statins and/or other cardiovascular drugs in combination that have an effect on mortality remains to be seen."

Dr Potluri concluded: "Patients with cancer who are at high risk or have established cardiovascular disease should be given statins as per current guidelines. I don't think at the moment we can give statins for cancer per se. But this could change if there was a positive result in the clinical trial."

Moderate-to-vigorous physical activity is related to improved subjective memory in breast cancer survivors, who often complain about memory problems, reports a new Northwestern Medicine study. It appears the physical activity alleviates stress and benefits women psychologically, which in turn aids their memory.

A surprising finding is memory problems appear to be related to the high stress load cancer survivors experience, and may not be specific to chemotherapy or radiation treatments.

"Our research suggests these self-reported memory problems may be emotionally related," said lead author Siobhan Phillips, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. "These women are frightened, stressed, fatigued, tapped out emotionally and have low self-confidence, which can be very mentally taxing and can lead to perceived memory problems."

The study will be published July 8 in the journal Psycho-Oncology.

Phillips also is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

In the study, more physical activity was associated with higher levels of self-confidence, lower distress and less fatigue, which in turn is associated with lower levels of perceived memory impairment.

Investigators looked at memory and exercise in breast cancer survivors in two study arms: one in self-reported data for 1,477 women across the country; the other in accelerometers worn by 362 women. The findings linking improved memory to higher levels of physical activity were consistent across both groups.

Friday, July 1, 2016

Bacteria that have the potential to abet
breast cancer are present in the breasts of cancer patients, while
beneficial bacteria are more abundant in healthy breasts, where they may
actually be protecting women from cancer, according to Gregor Reid,
PhD, and his collaborators. These findings may lead ultimately to the
use of probiotics to protect women against breast cancer. The research
is published in the ahead of print June 24 in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.

In the study, Reid's PhD student Camilla Urbaniak obtained breast
tissues from 58 women who were undergoing lumpectomies or mastectomies
for either benign (13 women) or cancerous (45 women) tumors, as well as
from 23 healthy women who had undergone breast reductions or
enhancements. They used DNA sequencing to identify bacteria from the
tissues, and culturing to confirm that the organisms were alive. Reid is
Professor of Surgery, and Microbiology & Immunology at Western
University and Director, Canadian Centre for Human Microbiome and
Probiotic Research at Lawson Health Research Institute in London,
Ontario, Canada.

Women with breast cancer had elevated levels of Escherichia coli and Staphylococcus epidermidis,
are known to induce double-stranded breaks in DNA in HeLa cells, which
are cultured human cells.

"Double-strand breaks are the most detrimental
type of DNA damage and are caused by genotoxins, reactive oxygen
species, and ionizing radiation," the investigators write. The repair
mechanism for double-stranded breaks is highly error prone, and such
errors can lead to cancer's development.
Conversely, Lactobacillus and Streptococcus,
considered to be health-promoting bacteria, were more prevalent in
healthy breasts than in cancerous ones. Both groups have
anticarcinogenic properties. For example, natural killer cells are
critical to controlling growth of tumors, and a low level of these
immune cells is associated with increased incidence of breast cancer. Streptococcus thermophilus produces anti-oxidants that neutralize reactive oxygen species, which can cause DNA damage, and thus, cancer.

The motivation for the research was the knowledge that breast cancer
decreases with breast feeding, said Reid. "Since human milk contains
beneficial bacteria, we wondered if they might be playing a role in
lowering the risk of cancer. Or, could other bacterial types influence
cancer formation in the mammary gland in women who had never lactated?
To even explore the question, we needed first to show that bacteria are
indeed present in breast tissue." (They had showed that in earlier
research.)
But lactation might not even be necessary to improve the bacterial
flora of breasts. "

Colleagues in Spain have shown that probiotic
lactobacilli ingested by women can reach the mammary gland," said Reid.
"Combined with our work, this raises the question, should women,
especially those at risk for breast cancer, take probiotic lactobacilli
to increase the proportion of beneficial bacteria in the breast? To
date, researchers have not even considered such questions, and indeed
some have balked at there being any link between bacteria and breast
cancer or health."

Besides fighting cancer directly, it might be possible to increase
the abundance of beneficial bacteria at the expense of harmful ones,
through probiotics, said Reid. Antibiotics targeting bacteria that abet
cancer might be another option for improving breast cancer management,
said Reid.

In any case, something keeps bacteria in check on and in the breasts,
as it does throughout the rest of the body, said Reid. "What if that
something was other bacteria--in conjunction with the host immune
system? We haven't answered this question, but it behooves experts in
the field to now consider the potential."

A family of proteins that help cancer cells survive and spread around the body may be associated with improved prognosis for some women receiving treatment for breast cancer, research has shown.

The study, led by academics at The University of Nottingham and published online by the academic journal Oncotarget, discovered that when high levels of the protein calpain were detected in large primary breast tumours from patients given chemotherapy treatment to shrink their tumour before surgery, these patients were more likely to survive.

The latest research involved biopsy specimens taken from women aged between 23 and 83 years old who were treated at the Leeds Teaching Hospitals NHS Trust between 2005 and 2009 for inflammatory and non-inflammatory breast cancer.

It looked at the expression of calpain in the initial tumour biopsy and again in the biopsied tumour removed following adjuvant chemotherapy which is designed to shrink the cancer before surgery.

The levels of calpain and the resulting survival rates were analysed and those patients with higher levels of calpain were associated with an improved survival rate.

The full academic paper, The Calpain System is Associated with Survival of Breast Cancer Patients with Large but Operable Inflammatory and Nob-Inflammatory Tumours Treater with Neoadjuvant Chemotherapy, can be found on the Oncotarget website.

Additional research funding to continue the work is currently being raised through the University's Life Cycle 6 campaign, which will see a team of University of Nottingham staff undertaking a gruelling 1,400 mile endurance bike ride this August to the four corners of Britain.

As well as sponsoring the endurance cyclists and taking part in the community bike ride, the University is encouraging people to hold their own fundraising events such as bake sales, dress down days, sky dives and charity discos. A list of ideas and more information features on the Life Cycle website.

The fundraising will support experts at Nottingham who are working on stopping the spread of breast cancer. The research focusses on understanding how breast cancer can spread outside of the breast and grow in other places around the body and what we can do to stop this process.

Increased risk for aggressive serous/serous-like endometrial cancer was increased in women with BRCA1 mutations, although the overall risk for uterine cancer after risk-reducing salpingo-oophorectomy (RRSO) to remove the fallopian tube and ovary was not increased, according to a new study published online by JAMA Oncology.

RRSO is part of the standard treatment for women with BRCA mutations but the role of accompanying hysterectomy remains controversial. Clarifying the issue is relevant because serous/serous-like subtypes account for only about 10 percent of uterine cancer cases but more than 40 percent of deaths due to the disease.

Noah D. Kauff, M.D., of the Duke University Health System, Durham, N.C., and coauthors looked at the risk of uterine cancer after RRSO in women with mutations in the BRAC1 and BRCA2 gene. The study included 1,083 women without a prior or associated hysterectomy; 67.1 percent had a history of breast cancer and 29.4 percent of 928 women with data available had used tamoxifen.

Researchers documented eight uterine cancers among the 1,083 women. Five of 627 women with BRAC1 mutations developed uterine cancer and three of 453 women with BRCA2 mutations developed uterine carcinoma.

Five serous/serous-like endometrial carcinomas were observed about seven to 13 years after RRSO (4 in women with BRCA1mutations and one in a woman with BRCA2 mutations). In 4 of 5 serous/serous-like cancers, the women had prior breast cancer, three of whom used tamoxifen, according to the results.

The authors estimate a 2.6 percent risk of developing serous/serous-like carcinoma through age 70 for a women with BRCA1 mutation undergoing RRSO at age 45.

"These results suggest that BRCA1+ women undergoing RRSO without hysterectomy remain at increased risk for serous/serous-like endometrial carcinoma," the author wrote. They note that although their work is the largest prospective study to date, relatively few cancer cases were observed.

"Although instability in the estimated magnitude of this risk remains, we believe that the possibility of this cancer should be considered when discussing the advantages and risks of hysterectomy at the time of RRSO in BRCA1+ women," the authors conclude.

Researchers at Cardiff University have found that online information about ovarian cancer can cause as much worry as comfort for women at high risk of developing the disease, in a new study published in ecancer.

For women at an increased risk of ovarian cancer but who haven't yet developed the disease, the most effective way to manage their risk is to surgically remove their fallopian tubes and ovaries.

However when interviewed, the women faced with this choice reported that the information available online often increased feelings of worry and fear rather than better informing their choices -- suggesting that patients' independent research needs to be guided by their healthcare professionals.

"Sometimes, online information helped these women to increase their confidence when it came to talking to health professionals about ovarian cancer," says study author Dr Stephanie Smits of Cardiff University, Cardiff, UK. "It was also described negatively, with the women feeling that it might be best to avoid seeking information altogether. Information about ovarian cancer was perceived by these patients to be a double-edged sword."

"Not all information on the internet is based on evidence, so people need to make sure they are looking at credible websites."

Dr Smits suggests that women at high risk of ovarian cancer should always seek guidance from their healthcare professionals and ovarian cancer charities for websites and resources that are helpful and reliable. "Doctors need to help in the search for high quality information, and management of anxiety that information might cause," she says.

She noted that websites with monitored content, such as NHS Choices, are good places to start the independent research process.

Support for this argument comes from low patient awareness about ovarian cancer, including lack of knowledge about the effectiveness of current screening options, and confusion over ovarian cancer symptoms.

Ovarian cancer was once described as "the silent killer," but this has been discounted over the years due to the increased understanding that it does indeed have symptoms.

It's clear that increased awareness of symptoms and access to reliable information have a role to play in reducing anxiety and improving outcomes for women with ovarian cancer.

Women who carry the BRCA1 gene mutation that dramatically increases their risk of breast and ovarian cancers are also at higher risk for a lethal form of uterine cancer, according to a study led by a Duke Cancer Institute researcher.

This newly defined risk - the first to show a conclusive link between the BRCA1 gene mutation and a small but significant chance of developing an aggressive uterine cancer - could become a consideration in weighing treatment options.

Currently, women with the BRCA1 mutation often have preventive surgeries to remove both breasts, as well as their ovaries and fallopian tubes, based on studies showing that the gene mutation elevates their risk for cancers in those organs.

But conflicting evidence has created controversy over the need to remove the uterus. Smaller studies identified a link between the gene mutation and uterine cancer, but the evidence to change practice has hinged on results from a well-designed study using a larger patient population from multiple sites.

"This is the study that has been needed," said lead author Noah D. Kauff, M.D., who leads the Clinical Cancer Genetics Program at the Duke Cancer Institute. "Our study presents the strongest evidence to date that women with this genetic mutation should at least discuss with their doctors the option of having a hysterectomy along with removal of their ovaries and fallopian tubes."

In the current study, published online June 30 in the journal JAMA Oncology, Kauff and colleagues from nine other institutions in the U.S. and the United Kingdom analyzed data from 1,083 women. All had BRCA1 or BRCA2 genetic mutations, had undergone removal of their ovaries and fallopian tubes, and were followed for a median 5.1 years.

Incidences of uterine cancer in the BRCA-positive women in the study were compared to the rates that would be expected in the general population, based on data from the U.S. government's Surveillance, Epidemiology, and End Results program, or SEER.

Among the BRCA-positive women, there were eight uterine cancers reported within the study period - a rate that was slightly higher but not statistically different than the national norm.

Of those eight cancers, however, five were of an uncommon subtype called serous endometrial cancer, which is especially aggressive. All but one of the serous endometrial cancers occurred in women with the BRCA1 genetic mutation (one occurred in a patient with BRCA2 mutation).

Given the incidence of this cancer in the wider population, only about .18 cases would be expected among women with the BRCA1 mutation over the time period analyzed, putting these women with the BRCA1 trait at significantly higher risk.

"We were surprised when we saw the data," Kauff said. "This is an event that should not occur in the over 600 women with BRCA1 mutations in our study. Even if we followed these women for 25 years, you would only expect to see no more than one serous cancer."

Kauff said the findings are especially important because serous endometrial cancer has a mortality rate of 50 percent and is preventable for women who are already undergoing surgical procedures to remove their ovaries and fallopian tubes.

"Our findings suggest that it may be important for women with BRCA1 mutations to consider removing their uterus at the time they are considering removing their ovaries and fallopian tubes, unless they are hoping to still have children using assisted reproductive methods or have other medical reasons," Kauff said.

Kauff cautioned that for women with BRCA1 mutations who have already undergone surgeries to remove their ovaries and fallopian tubes, the findings are less clear.

"We need additional studies to address whether a 25-year risk of serous uterine cancer of 2.6 percent to 4.7 percent justifies the costs and potential complications of a second surgery," Kauff said.

When a woman is diagnosed with the earliest stage of breast cancer, how aggressive should her treatment be? Will the non-invasive cancer become invasive? Or is it a slow-growing variety that will likely never be harmful?

Researchers at the University of Michigan developed a new technology that can identify aggressive forms of ductal carcinoma in situ, or stage 0 breast cancer, from non-aggressive varieties.

"A patient with DCIS is typically treated as if she has invasive disease, which is easy to understand. When women hear breast cancer, they're petrified. And physicians are keenly concerned about outcomes as well," says study author Howard R. Petty, Ph.D., professor of ophthalmology and visual sciences and of microbiology and immunology.

"But, DCIS is not the same disease for everyone. If we can identify potentially non-aggressive lesions, perhaps those women don't need aggressive treatment."

BRIM combines traditional pathology techniques and fuses it with mathematical analysis to determine the relative levels of certain biomarkers in a tumor.

Petty and co-author Andrea J. Clark looked at biopsy samples from 23 patients with DCIS. They used fluorescence imaging, in which tumors are stained to identify key biomarkers. Each biomarker was stained a different color. The stained samples were then entered into a computer program that determines the ratio of biomarker in each pixel.

Some biomarkers are highly expressed in cancer; others have very low expression. With BRIM, researchers take the ratio of expression. This means high and low do not cancel each other out, but rather combine to form an image of improved contrast.

Using this technique, researchers could separate the DCIS patient samples into those with a lot of cancer stem cells - which are highly aggressive - and those that resembled benign tumors. They found 22 percent of the samples had low scores suggestive of very slow-growing, non-aggressive disease.

"This approach is going to be a new and powerful one. It works because we're looking at it mathematically," Petty says. The results are published in the Nature journal Scientific Reports.

Ratio imaging microscopy was used in the 1990s to look at calcium signals. Here, the researchers resurrected this technique and applied it using antibodies and biomarkers.

Biomarkers were selected based on an extensive literature search. The researchers suggest that another advantage to BRIM is that it combines multiple biomarkers, rather than relying on a single marker.

Rates of ductal carcinoma in situ have increased since screening mammography became common. Some experts believe that DCIS can become invasive breast cancer, but this has not been proven. Currently, there is not a way to stratify the disease based on aggressiveness.

The researchers suggest that in addition to preventing overtreatment, BRIM could be used to help more broadly with breast cancer treatment decisions. As the biomarker literature becomes more expansive in other cancer types, the researchers say they will expand their work to other forms of cancer.

They plan to conduct a large retrospective study correlating BRIM scores to patient outcomes.